Read ANALYSIS OF 50 CASES OF M.E. TREATED WITH CHINESE HERBS AND ACUPUNCTURE text version

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

ANALYSIS OF 50 CASES OF M.E. TREATED WITH CHINESE HERBS AND ACUPUNCTURE

by Dr. Dan Jiang and Paul Franks ABSTRACT

M.E. (Myalgic Encephalomyelitis) is a chronic disease characterised by disabling fatigue and exhaustion together with a diverse range of symptoms. `Myalgic' means pain in the muscles and `encephalomyelitis' means inflammation of the brain and nerves. Although M.E. is a common disease in the West, it has only recently been recognised, and as yet no Western medical treatment of sustained effectiveness is available. By using a combination of acupuncture and Chinese herbal medicine, however, we have seen a marked improvement in health. The treatment can be summarised as: · In diagnosis, the following observation was made: "the more the myalgia, the more the pathogenic dampness". · In formulating the herbal prescription, the first aim is to resolve dampness and clear pathogenic factors. · When selecting acupuncture points, expelling pathogenic factors and tonifying the body should be concurrent aims, dealt with according to presentation. · Use Du Mai and scalp points in addition to other channel points, especially if head symptoms predominate (poor concentration and memory, headache, insomnia, light headedness, mental exhaustion and depression). somnia, light headedness, dizziness, blurred vision, eye pain and light sensitivity, gastrointestinal disturbance and abdominal pain, depression, fever, chills and night sweats, recurrent sore throat, lymph node tenderness, skin rashes and neurologic complaints1. All patients came with a diagnosis of M.E. or Post Viral Fatigue and had routine medical investigations which were normal. M.E. frequently follows an active viral infection. It has been estimated that about 75% of cases follow a definitive virus, commonly influenza or gastroenteritis2. However not all infections associated with M.E. are viral. Often the only evidence for infection at the onset is a history of febrile illness, perhaps with pharyngitis or lymphadenopathy, or a full blood count may have revealed some atypical mononuclear cells. Sometimes M.E. occurs as a sequela of otitis media, hepatitis, glandular fever etc. During the acute phase the patient will have fever, chills, cough, otalgia, pharyngalgia, diarrhoea, gastralgia etc., but when these symptoms improve, other symptoms gradually appear, such as lack of energy, tiredness and drowsiness, dull blank complexion, poor memory, poor concentration, a decline in capacity for either physical or mental work, muscle aches, headache etc. In such cases, the Western medical treatment is usually rest, administration of fluids and possibly analgesics. These symptoms, however, may last for several or even tens of years if not successfully treated, and patients may totally lose their capacity to work. It appeared to us that M.E. is like an immune reaction disease, where the body is trying to protect itself from attack. In TCM this involves retained pathogenic factors, along with Qi deficiency. Many of the TCM syndromes seen in M.E. had previously been explained in an article by Giovanni Maciocia, JCM No. 353. In our 50 cases, however, the most relevant pathogen was dampness. From our observations, the symptoms of M.E. as well as the presence of a thick greasy tongue coating and a floating and soggy (Ru) pulse during the acute period, are similar to those of Chun Wen (heat in Spring*) and Shi

* Heat in Spring (Chun Wen) is a disease referred to in the Wen Bing Tiao Bian, which explains how cold or other pathogens may enter the body in Winter but symptoms, usually characteristic of a heat syndrome, only appear in Spring. This is similar to the idea of residual pathogenic factor4.

INTRODUCTION

In Western medicine, M.E. is controversial in terms of cause, treatment, and even the definition of the syndrome. Part of the problem is the lack of a conclusive diagnostic test; diagnosis is usually made by exclusion. This confusion is illustrated by the huge variety of names given to the the disease, such as Chronic Fatigue Immune Dysfunction Syndrome (CFIDS), Chronic EpsteinBarr Virus Syndrome, Post-Viral Fatigue Syndrome and Chronic Fatigue Syndrome. For the purpose of this analysis, we looked at patients who had been symptomatic for at least six months and had chronic and persistent fatigue as a universal symptom. The differentiation of ME, CFIDS, PVS etc. is irrelevant in TCM. Other symptoms, present in different combinations, included headaches, muscle pain, joint pain, confusion, poor concentration and memory, in-

13 12

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

Wen (damp-heat) described in the Wen Bing Tiao Bian (Differentiation of Syndromes of Heat Diseases by Wu Jutong, Qing dynasty). We therefore considered that pathogenic dampness is a significant primary cause of the disease, complicated by heat, stagnation and deficiency. We also found that a combination of acupuncture and Chinese herbs were more effective than just one of these therapies used in isolation. The following report details our analysis, therapeutic procedures and results in the treatment of 50 cases of M.E. syndrome. All 50 patients were from Britain - 38 were female and 12 were male. The youngest was 14 and the eldest 72. The shortest duration of disease was 6 months and the longest 12 years (some of the patients were not able to tell exactly how long the disease had been going on). The initial diseases were as follows: influenza or common cold (21), otitis media (3), enteritis (5), hepatitis (3), pneumonia (2), gastritis (5), pharyngitis (2), while in 9 cases the cause was not clear.

DIFFERENTIATION AND TREATMENT

The acute stage

The `acute stage' means the period in which the patient is still showing symptoms of the initial disease. The course of the disease is short (from 3 months to one year), and most patients manifest a Shi (excess) pattern. Symptoms · Continuous or repeated `flu-like symptoms, pharyngalgia, blocked or runny nose, chills, swollen glands, or symptoms from the initial disease (hepatitis, gastritis or glandular fever) such as vomiting, nausea, diarrhoea, cough etc. · General soreness and pain, such as pains in the muscles, neck, head, body, stomach, costal and hypochondriac regions and abdomen. Most of these pains are migratory in nature and some of them are very severe and sharp. · General fatigue: lack of energy, exhaustion, weariness, lack of expression, loss of memory, lack of concentration, reduced capacity for work, insomnia, dizziness, nervousness.

Differentiation of patterns

1. Damp-heat accumulated in the interior These patients manifest both pronounced pathogenic dampness and pronounced pathogenic heat. Combined dampness and heat escalate in the interior. This pattern is most common in younger patients, or in those who were healthy before having M.E. syndrome. Damp-heat in the interior may be further differentiated into dampheat accumulated in the upper jiao, damp-heat accumulated in the middle jiao, and damp-heat throughout the three jiao: i. Damp-heat accumulated in the upper jiao - sore and dry throat - turbid nasal discharge - tinnitus - headache - pain in the shoulders, neck, and back

Tongue: light red tongue with scanty yellow-greasy coating Pulse: Soggy (Ru) Treatment principle: clear Lung heat and resolve exterior dampness. Prescription: Huo Po Xia Ling Tang (Agastache, Magnolia Bark, Pinellia and Poria Decoction), or Yin Qiao San (Honeysuckle and Forsythia Powder) with the addition of herbs that eliminate dampness. Herbs to be used: Huo Xiang (Herba Agastaches seu Pogostemi) 6g Hou Po (Cortex Magnoliae Officinalis) 6g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Fu Ling (Sclerotium Poriae Cocos) 9g Xing Ren (Semen Pruni Armeniacae) 8g Yi Yi Ren (Semen Coicis Lachryma-jobi) 9g Pei Lan (Herba Eupatorii Fortunei) 6g Jin Yin Hua (Flos Lonicerae Japonicae) 9g Lian Qiao (Fructus Forsythiae Suspensae) 6g Zhu Ye (Herba Lophatheri Gracilis) 6g Niu Bang Zi (Fructus Arctii Lappae) 6g etc. ii. Damp-heat accumulated in the middle jiao - poor appetite - fullness and distention in the chest and epigastrium - stuffiness and pain in the hypochondriac region - tiredness and drowsiness - aching muscles - feeling of heaviness in the body and head - loose stools or diarrhoea - sticky-taste in the mouth - a muzzy feeling in the brain Tongue: red with yellow-greasy coating, thick in the middle portion Pulse: slippery (Hua) and rapid (Shu) Treatment principle: drain dampness and expel heat, regulate and move the interior Qi . Prescription: Lian Po Yin (Coptis and Magnolia Bark Decoction) with the addition of herbs that regulate Qi. Herbs to be used: Huang Lian (Rhizoma Coptidis) 5g Hou Po (Cortex Magnoliae Officinalis) 6g Zhi Zi (Fructus Gardeniae Jasminoidis) 6g Shi Chang Pu (Rhizoma Acori Graminei) 3g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Lu Gen (Rhizoma Phragmitis Communis) 12g Hua Shi (Talcum) 15g Mu Xiang (Radix Saussureae seu Vladimirae) 5g Chai Hu (Radix Bupleuri) 6g etc. iii. Damp-heat throughout the three jiao - poor appetite - fullness and distention in the abdomen - loose stools or diarrhoea, or constipation - nausea - aching, heaviness and stiffness in the limbs and back - weary feeling in the whole body, lack of energy - scanty urine - leucorrhoea - dull blank complexion, dull response Tongue: red with yellow-greasy coating Pulse: slippery (Hua)

14 13

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

Treatment principle: expel heat and drain dampness, clear the water passages of the three jiao. Prescription: Chang Pu Yu Jin Tang (Acorus and Curcuma Decoction) with the addition of herbs which will effectively purge dampness. Herbs to be used: Shi Chang Pu (Rhizoma Acori Graminei) 3g Yu Jin (Tuber Curcumae) 6g Zhi Zi (Fructus Gardeniae Jasminoidis) 6g Lian Qiao (Fructus Forsythiae Suspensae) 6g Hua Shi (Talcum) 15g Zhu Ye (Herba Lophatheri Gracilis) 6g Mu Dan Pi (Cortex Moutan Radicis) 6g Zhu Ru (Caulis Bambusae in Taeniis) 6g Niu Bang Zi (Fructus Arctii Lappae) 6g Che Qian Zi (Semen Plantaginis) 9g Huai Shan (Radix Dioscoreae Oppositae) 6g etc. 2. Predominance of dampness accumulated in the interior Here there is excess of pathogenic dampness, but no obvious appearance of pathogenic heat. This pattern usually occurs in those who are physically deficient, or in women over middle-age. Clinical manifestations include: - soreness and stuffiness sensation in the whole body - vague aches and pains - drowsiness - insomnia - amnesia - blurred vision and dizziness - loose stools - leucorrhoea Tongue: light red with white-greasy coating Pulse: slippery (Hua) Treatment principle: drain dampness and regulate Qi. Prescription: San Ren Tang (Three Nut Decoction). The nature of the herbs used should not be too cold, but they must be strong enough to remove the dampness. Herbs to be used: Xing Ren (Semen Pruni Armeniacae) 6g Yi Yi Ren (Semen Coicis Lachryma-jobi) 6g Bai Dou Kou (Fructus Cardamomi Rotundi) 3g Hua Shi (Talcum) 15g Hou Po (Cortex Magnoliae Officinalis) 5g Mu Tong (Caulis Mutong) 5g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Zhu Ye (Herba Lophatheri Gracilis) 9g etc. 3. Excessive cold and damp. This is excessive pathogenic dampness combined with cold. This pattern is usually seen in patients who have a cold constitution. Clinical manifestations include: - blurred vision and dizziness - feeling of bloating and pain in the stomach - chilled and cold limbs - loose stools or diarrhoea - cold sensation in the lower abdomen - soreness and aching in the whole body - lack of energy, tiredness, drowsiness - insomnia - amnesia

Tongue: pale with white coating Pulse: slow (Chi) and slippery (Hua) Treatment principle: warm and dispel cold and damp. Prescription: Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction) and Wu Zhu Yu Tang (Evodia Decoction). Herbs to be used: Fu Ling (Sclerotium Poriae Cocos) 9g Gui Zhi (Ramulus Cinnamomi Cassiae) 6g Bai Zhu (Rhizoma Atractylodis Macrocephalae) 6g Gan Cao (Radix Glycyrrhizae Uralensis) 3g Wu Zhu Yu (Fructus Evodiae Rutaecarpae) 3g Dang Shen (Radix Codonopsis Pilosulae) 6g Gan Jiang (Rhizoma Zingiberis Officinalis) 6g etc. 4. Excess heat in interior Patients of this type do not have much pathogenic dampness, but have excessive pathogenic heat. They are usually habitual smokers or drinkers and are often quicktempered. Clinical manifestations include: - pain and heaviness in the head and body - irritability - insomnia - tinnitus - bitter taste and smell in the mouth - fullness and distention in the chest - constipation - hiccups and sighing - fullness and pain in hypochondriac region, chest and back - dry and gritty sensation in the eyes Tongue: red with yellow-greasy coating Pulse: wiry (Xian) and rapid (Shu) Treatment principle: clear heat and dry damp. Prescription: Long Dan Xie Gan Tang (Gentiana Longdancao Decoction to Drain the Liver). Herbs to be used: Long Dan Cao (Radix Gentianae Scabrae) 6g Huang Qin (Radix Scutellariae Baicalensis) 6g Zhi Zi (Fructus Gardeniae Jasminoidis) 6g Chai Hu (Radix Bupleuri) 5g Hua Shi (Talcum) 15g Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 6g Mu Tong (Caulis Mutong) 5g Dang Gui (Radix Angelicae Sinensis) 6g Sheng Di Huang (Radix Rehmanniae Glutinosae) 9g etc.

The chronic stage

With some patients, this stage could well last over 1-2 years. During this period, although the initial disease may reoccur now and again, it is not now prominent. The main symptoms are lack of energy and drowsiness, with reduced capacity to work. It is a pattern of deficiency (Xu) mixed with excess (Shi). Symptoms General exhaustion is the main symptom, along with fatigue, insomnia, amnesia, drowsiness, reduced or even lost capacity to work, easy infection by pathogenic factors, and aching or pains in the muscles. The degree of myalgia depends on how much dampness has been accumulated. This is reflected in the saying: "the more the pathogenic dampness, the more the myalgia".

15 14

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

Diagnosis and differentiation of patterns

The chronic stage may be differentiated into Qi deficiency mingled with dampness, Yin deficiency mingled with dampness, Yang deficiency mingled with dampness, pathogenic dampness accumulated over a long period, and pathogenic dampness and heat accumulated over a long period: 1. Qi deficiency mingled with dampness - bloated sensation with pain in the stomach - abdominal distention and gurgling - poor appetite - loose stools - lack of energy, drowsiness - shortness of breath - being too lethargic to speak - pale or puffy complexion Tongue: pale with white coating Pulse: thready (Xi) and slippery (Hua) Treatment principle: reinforce Qi and dry or drain dampness. Prescription: Xiang Sha Liu Jun Zi Tang (Six-Gentleman Decoction with Aucklandia and Amomum). Herbs to be used: Dang Shen (Radix Codonopsis Pilosulae) 9g Bai Zhu (Rhizoma Atractylodis Macrocephalae) 6g Chen Pi (Pericarpium Citri Reticulatae) 6g Sha Ren (Fructus seu Semen Amomi) 4g Xiang Fu (Rhizoma Cyperi Rotundi) 6g Fu Ling (Sclerotium Poriae Cocos) 6g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Gan Cao (Radix Glycyrrhizae Uralensis) 4g plus Che Qian Zi (Semen Plantaginis) 6g Yi Yi Ren (Semen Coicis Lachryma-jobi) 6g etc. 2. Yin deficiency mingled with dampness - epigastric distress - dry mouth - dull complexion - loss of weight - erratic fever in the afternoon or evening - irritability - insomnia Tongue: deep red with scanty white coating Pulse: thready (Xi) Treatment principle: tonify Yin and eliminate dampness. Prescription: Shen Ling Bai Zhu San (Ginseng, Poria and Atractylodes Macrocephala Powder) or Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). Use together if there is pronounced dampness and Yin-Xu. Herbs to be used: Shan Yao (Radix Dioscoreae Oppositae) 6g Bai Bian Dou (Semen Dolichoris Lablab) 9g Tai Zi Shen (Radix Pseudostellariae Heterophyllae) 9g Bai Zhu (Rhizoma Atractylodis Macrocephalae) 9g Lian Zi Xin (Plumula Nelumbinis Nuciferae) 3g Sha Ren (Fructus seu Semen Amomi) 5g Yi Yi Ren (Semen Coicis Lachryma-jobi) 6g Da Zao (Fructus Zizyphi Jujubae) 6g If necessary add: Sheng Di Huang (Radix Rehmanniae Glutinosae) 9g Shan Zhu Yu (Fructus Corni Officinalis) 6g

Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 9g Fu Ling (Sclerotium Poriae Cocos) 9g etc. 3. Yang deficiency mingled with dampness - lack of energy - tiredness - heaviness of the whole body - oedema of the lower legs - thin leucorrhoea Tongue: pale and plump with tooth marks, white coating Pulse: weak (Xu) and thready (Xi) pulse. Treatment principle: warm the Yang and purge water. Prescription: Zhen Wu Tang (True Warrior Decoction) or You Gui Yin (Restore the Right [Kidney] Decoction). Herbs to be used: Fu Zi (Radix Aconiti Carmichaeli Praeparatae) 3g Rou Gui (Cortex Cinnamomi Cassiae) 2g [or Gui Zhi (Ramulus Cinnamomi Cassiae) 4g] Fu Ling (Sclerotium Poriae Cocos) 6g Zhu Ling (Sclerotium Polypori Umbellati) 6g Bai Zhu (Rhizoma Atractylodis Macrocephalae) 6g, or Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 9g Shan Zhu Yu (Fructus Corni Officinalis) 6g Gou Qi Zi (Fructus Lycii Chinensis) 6g Du Zhong (Cortex Eucommiae Ulmoidis) 6g Rou Gui (Cortex Cinnamomi Cassiae) 2g Fu Zi (Radix Aconiti Carmichaeli Praeparatae) 3g Rou Cong Rong (Herba Cistanches) 6g Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 3g 4. Pathogenic dampness accumulated over a long period 5. Pathogenic dampness and heat accumulated over a long period These two patterns (4. and 5.) have the same symptoms as tin the acute period. That is, although the patients might have had the disease for a long time, they do not appear weaker, retaining strong antipathogenic Qi, so the treatment principles and prescriptions are similar to those of similar patterns seen during the acute phase. If symptoms of deficiency occur, tonic herbs can be given.

TREATMENT PROCEDURE

Acupuncture

Main Points: Baihui DU-20 Dazhui DU-14 Explanation: · Baihui DU-20 benefits and clears the brain, dispels wind, raises central Qi, restores collapsed Yang and calms the spirit. · Dazhui DU-14 clears the brain and calms the spirit, clears heat (especially residual heat), dispels wind and restores collapsed Yin. Secondary points during the acute phase: Quchi L.I.-11 Fengchi GB-20 Sanyinjiao SP-6 Taichong LIV-3

16 15

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

Neiting ST-44 Hegu L.I.-4, etc. Explanation: · Quchi L.I.-11 clears heat and fire, transforms damp heat, reduces fever and dispels wind. · Fengchi GB-20 releases exterior conditions, dispels wind, facilitates Qi flow and clears the senses. · Sanyinjiao SP-6 clears fire due to deficiency, nourishes Yin, cools heat, resolves dampness and damp-heat and regulates the water pathways. · Taichong LIV-3 transforms damp heat (especially Liver and Gallbladder), regulates and tonifies the Liver, regulates Qi and alleviates pain. · Neiting ST-44 transforms damp heat and drains pathogenic factors from the Stomach. Use with Quchi L.I.-11 for Yangming stage heat. · Hegu L.I.-4 alleviates exterior conditions, reduces fever, transforms phlegm, regulates and tonifies Qi (especially Wei Qi) and alleviates pain. Secondary points during the chronic phase: Feishu BL-13 Xinshu BL-15 Pishu BL-20 Ganshu BL-18 Shenshu BL-23 Mingmen DU-4 Explanation: · Feishu BL-13 regulates the upper jiao, tonifies Lung, dispels wind, transforms phlegm, clears heat and releases the exterior. · Xinshu BL-15 regulates the upper jiao, tonifies the Heart, clears Heart heat and fire, calms the spirit and strengthens and clears the brain. · Pishu BL-20 tonifies Spleen Qi and Yang, tonifies nutritive (Ying) Qi and blood, transforms damp heat and raises the middle Qi. · Ganshu BL-18 regulates and tonifies the Liver, transforms damp heat and clears heat (especially Liver and Gall Bladder) and disperses Liver Qi. · Shenshu BL-23 tonifies Kidney Qi and Yang, regulates the lower jiao, tonifies Yuan Qi and Jing, regulates the water pathways, resolves damp and strengthens the brain. · Mingmen DU-4 tonifies the Kidneys, Yuan Qi and Jing, regulates the water passages, resolves dampness, calms the spirit, strengthens and clears the brain and restores collapsed Yang. In clinical practice, add or reduce points according to symptoms, areas of pain involved and pattern.

safer to use over longer periods. They are generally used after a course of herbal decoctions.

Other therapies

These therapies are used according to the presenting conditions of different cases: · For patients who have severe muscle pain, we use auricular needles or seeds embedded in auricular points for consolidating the effects of the acupuncture. · For patients suffering from exhaustion, we use dermal needles embedded in Back-Shu points for lasting effect. · For patients with deficiency of Yang, and the presence of pathogenic cold, we use cupping or moxibustion for strengthening the effects of acupuncture.

Analysis of Results

M.E.syndrome is a chronic disease, and the incidence of relapse is high, even among patients who were markedly improved. The treatment therefore usually takes a long time. The longest period of treatment we gave to a patient was over 4 years. Usually, the reason that patients did not recover is that they stopped treatment early. Definition of standards of results · Apparent recovery: disappearance of symptoms, restoration of a healthy expression and emotional wellbeing and normal capacity to work. · Markedly improved: disappearance of `flu-like symptoms and muscle aching, a healthier expression and ability to work part-time, but the symptoms may reoccur occasionally. · Improved: all the symptoms were less severe than before treatment. · No effect: most of this type were patients did not persist with treatment continuously. Results Apparent recovery: 18 Markedly improved: 10 Improved: 18 No effect: 4

Typical Case

Sex: Female Occupation: Computer programmer Age: 32 Chief Complaint: `Flu-like feeling, general aching and lack of energy for six months, getting worse in the last 2 weeks. History of Present Illness: She had suffered from influenza six months ago. At that time she had fever, chills, sore throat, catarrh, cough and general aching. Her GP gave her antibiotics and painkillers. She felt a bit better after taking them. Since then, she has had `flu repeatedly with sore throat, runny or blocked nose, cough, etc. Gradually she started to have headaches, dizziness, aching or pains in the body, lack of energy and difficulty in concentration, poor memory, a muzzy feeling of the brain and reduced capacity to work. The symptoms got worse with time. She was very worried and went to see her GP and went to hospital several times. All blood and urine samples and examinations were normal. She had taken many kinds of medical drugs, but they were not effec-

Chinese Herbs

As prescribed in the section on diagnosis and differentiation of syndromes (above). Herbal decoctions: Generally, we ask the patients to take decoctions for the first 2-4 weeks, as well as during any flare-up of severe symptoms, since they will bring quick and strong results. The doses given above are the lowest used. In clinical practice they can be adjusted according to the condition of the patient. Concentrated powders, or prepared herbal medicine: the effects of these are milder, they are easy to take and are

17 16

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

TRIGGER Viral or non-viral; vaccinations, stress, accident, enterovirus

PREDISPOSING FACTORS WHICH COMPROMISE IMMUNE FUNCTION

Poor diet, overwork, lack of rest, excessive antibiotics

*CYTOKINES Chemicals produced by the immune system to 'switch on' the immune response. Theory suggests that cytokines are continually produced after the initial trigger (virus etc.) has disappeared

OVER-ACTIVE IMMUNE RESPONSE Over-production of cytokines*

MUSCULAR CHANGES

Muscle atrophy, pain or aching, heaviness, weakness, sore areas

Reduced activity in some areas causes poor concentration and memory; hypothalmic disturbance leading to insomnia, digestive problems, mood changes Viruses can multiply within the CNS and muscles

Any initial viruses may or may not become persistent and other opportunistic viruses may move in

BRAIN

'Brain inflammation', neurochemical changes and muscular pathology. In some cases reactivation of the dormant HHV6 Herpes virus or the latent Epstein-Barr virus

Aetiology and Pathology of M.E. According to Western Medicine Theory (Remains controversial)

Pathogenic dampness

Interior heat complicated by antibiotics Heavy and fatty diet Emotional disharmony Excess alcohol Overwork Menstruation Pregnancy Excessive sex Accumulated heat in the interior Spleen deficiency Heat in the interior Deficiency of Qi and blood Damp and heat accumulated in the interior

M.E. Syndome

Damp accumulated in the interior Excess of both cold and damp

Qi deficiency mingled with damp

Yin deficiency mingled with damp

Yang deficiency mingled with damp

Prolonged accumulation Prolonged accumulation of damp of damp and heat

Chronic stage Aetiology and Pathology of M.E. According to TCM

18 17

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

tive. Two weeks ago, she had influenza again and all of her symptoms became worse. Present Symptoms: Headache, dizziness, aching or pain in the arm, leg and back muscles, sore throat, sticky sweat, tightness in the chest, heaviness of the head and legs, poor appetite, insomnia, loose stools, poor memory and lack of concentration, brain unclear, dry and sticky sensation in the mouth, thirst with no desire to drink, red tongue with a white greasy coating and a floating and fine (Ru) pulse.. Diagnosis and differentiation of patterns: Damp-heat accumulated in the three jiao, deficiency of Spleen and Heart. Treatment principle: Expel pathogenic factors first, then tonify the Qi. Treatment Procedure: Acupuncture: once a week. Chinese herbal powders: 4 grams twice a day. Stage 1: The aim at this stage is to purge damp, clear heat and expel wind from the exterior. Points: Dazhui DU-14 Baihui DU-20 Fengchi GB-20 Quchi L.I.-11 Feishu BL-13 Pishu BL-20 Herbal Medicine: Xing Ren (Semen Pruni Armeniacae) 6g Yi Yi Ren (Semen Coicis Lachryma-jobi) 6g Kou Ren (Fructus Amomi Cardamomi) 3g Mu Tong (Caulis Mutong) 6g Hua Shi (Talcum) 15g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Hou Po (Cortex Magnoliae Officinalis) 4g Zhu Ye (Herba Lophatheri Gracilis) 6g Pei Lan (Herba Eupatorii Fortunei) 6g Sheng Gan Cao (Radix Glycyrrhizae Uralensis) 4g Stage 2: After the first stage of treatment she felt better, the headache and dizziness had gone, the muscle aching was reduced, she could carry on working and her spirit was improved. She still has catarrh and sore throat and is more tired.Her tongue was still light red with white coating. The pulse was slippery (Hua) and thready (Xi). The aim at this stage was to drain damp and to clear heat, regulate the Qi and open the orifices. Points: Dazhui DU-14 Baihui DU-20 Toulinqi GB-15 Fengchi GB-20 Quchi L.I.-11 Jiache ST-6 (to dispel wind and heat, clear catarrh, mois ten the throat and ease sore throat). Herbal Medicine: Yi Yi Ren (Semen Coicis Lachryma-jobi) 6g Mu Tong (Caulis Mutong) 6g Hua Shi (Talcum) 15g Huang Qin (Radix Scutellariae Baicalensis) 9g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Hou Po (Cortex Magnoliae Officinalis) 6g Zhi Zi (Fructus Gardeniae Jasminoidis) 6g

Shi Chang Pu (Rhizoma Acori Graminei) 6g Yu Jin (Tuber Curcumae) 6g Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 4g Stage 3: Her `flu-like sensation and aching had gone completely. She felt stronger and could work full-time. But she still often felt tired after over-work and did not sleep very well. Her tongue was light red with less white coating and the pulse was slippery (Hua) and thready (Xi). The aim of treatment at this stage was to drain dampness, clear heat, tonify the Spleen and benefit Qi. Points: Dazhui DU-14 Baihui DU-20 Xinshu BL-15 Pishu BL-20 Shenshu BL-23 Hegu L.I.-4 Taichong LIV-3 Herbal Medicine: Yi Yi Ren (Semen Coicis Lachryma-jobi) 6g Mu Tong (Caulis Mutong) 6g Hua Shi (Talcum) 15g Huang Qin (Radix Scutellariae Baicalensis) 9g Ban Xia (Rhizoma Pinelliae Ternatae) 6g Fu Ling (Sclerotium Poriae Cocos) 6g Shan Yao (Radix Dioscoreae Oppositae) 6g Zhi Zi (Fructus Gardeniae Jasminoidis) 6g Shi Chang Pu (Rhizoma Acori Graminei) 6g Yu Jin (Tuber Curcumae) 6g Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 4g Stage 4: All of her symptoms had almost gone and she was very happy. Her tongue was light red with less white coating and the pulse was slippery (Hua). This patient was therefore considered as apparently recovered. The whole therapeutic period took a month.

Discussion

We adopted the combined therapies of acupuncture and Chinese herbs for the treatment of M.E. When using acupuncture, we applied different treatment principles according to different stages of the disease as appropriate.The basic pattern or syndrome was treated simultaneously with specific symptoms, for example pain in a channel or nausea. Points on the scalp were selected according to the individual case, but were found to be important where symptoms involving the head were predominant. Key points were Baihui DU-20 and Dazhui DU-14. During the acute stage the main treatment principle was to eliminate pathogenic factors and regulate Qi, whilst in the chronic stage the main treatment principle was to reinforce the zangfu and clear residual pathogenic factors. When using Chinese herbs we aimed to treat the pathogenic dampness, and according to different disease stages classified the disease as dampness and heat, dampness and cold, deficiency mingling with dampness and so on. By proceeding step by step we achieved satisfactory results. From our experience of using combined treatment we believe that acupuncture plays an important role in

19 18

JOURNAL OF CHINESE MEDICINE NUMBER 44 JANUARY 1994

reducing pain, controlling symptoms and improving the physical and mental condition, while Chinese herbs have more of an effect on clearing dampness and heat, warming cold, regulating Qi, nourishing Yin and blood, and harmonising Yin and Yang. The treatment of M.E. with the combined therapies of TCM appears to be very effective. Obviously dietary and lifestyle advice also play a significant part in a TCM approach to M.E. The treatment of M.E. by TCM is very encouraging and will be further improved if we stimulate research and share our experiences. A well designed clinical trial possibly including the SF-36 and a large sample size (about 200 patients) involving collaboration between TCM clinics could be the next step for further research.

* SF-36 - `Short Form 36' health survey questionnaire is a selfadministered questionnaire containing 36 items which takes about five minutes to complete. It measures health on eight multi-item dimensions covering functional status, well-being and overall evaluation of health. Items in the SF-36 are claimed to detect positive as well as negative states of health5. It has been used successfully by the British National Health Service and would work well with a TCM and M.E. research project.

References

1. Bell, David S. The Disease of a Thousand Names, Pollard Publications, 1991. 2. Bell, David, S. ibid. 3. Maciocia, Giovanni M.E., Journal of Chinese Medicine, Number 35, January 1991. 4. Wen Bing Tiao Bian (Systematic Differentiation of Warm Diseases), Wu Jutong, Qing dynasty. 5. Brazier, J.E. et. al. Validating the SF Health Survey Questionnaire BMJ, Vol. 305 July 18th 1992

Sources

· Macintyre, Anne M.E. Information for Doctors pub. M.E Action Campaign. · Willoughby, E. Myalgic Encephalomyelitis, New Zealand Medical Journal: 19, 20, January 15, 1989. · David, A.S. et.al. Post-Viral Fatigue Syndrome, British Medical Journal Clinical Research 296 (6623): 696-9, March 5th, 1988. · Maciocia, G. The Foundations of Chinese Medicine, Churchill Livingstone. · Lade, A. Images and Functions, Eastland Press. · Bensky, D. and Barolet, R. Formulas and Strategies, Eastland Press. Paul Franks: In the late '70's worked on a research orientated NHS psychiatric unit and used electro-acupuncture with heroin users. Trained at the College of Traditional Acupuncture in Leamington Spa, studied TCM on a Journal of Chinese Medicine course and Chinese Herbalism with the School of Chinese Herbal Medicine. Has been in practice in Sheffield since the early '80's, and as a social science graduate has a special interest in research. Dr. Dan Jiang: Graduated from the Beijing College of TCM in 1978 after studying both Western and Chinese medicine. A postgraduate from 1984-1987 at the same college, obtaining a M.Med.Sci. degree. After graduating in 1978 she became a lecturer at the Beijing College of TCM and was Charge Doctor at the First Hospital attached to the Beijing College. Author of three books and numerous articles on TCM and joint author of another two books. A similar article on M.E. was published in Norway. Dr. Jiang came to England in 1991 and practises at the Sheffield Clinic of Complementary Medicine.

20 19

Information

ANALYSIS OF 50 CASES OF M.E. TREATED WITH CHINESE HERBS AND ACUPUNCTURE

8 pages

Find more like this

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

109927


You might also be interested in

BETA
ANALYSIS OF 50 CASES OF M.E. TREATED WITH CHINESE HERBS AND ACUPUNCTURE